1. Field of the Invention
The field of the present invention relates to a locking mechanism to maintain three-dimensional closure of the longitudinal slot of a hollow tube, such as the type utilized in gastrointestinal endoscopy, especially colonoscopy. More specifically, the invention described herein is an improved locking mechanism that more securely and safely closes the slot so as to facilitate use of the slot for such procedures.
2. Background
As used herein, the terms xe2x80x9csplintxe2x80x9d, xe2x80x9csplinting devicexe2x80x9d, and xe2x80x9covertubexe2x80x9d are used interchangeably to refer to a generally elongated hollow tubular member that is adaptable for receiving a medical instrument, such as an endoscope. The term xe2x80x9cendoscopexe2x80x9d or xe2x80x9cscopexe2x80x9d is used to refer to a colonoscope, gastroscope, enteroscope, or other types of medical endoscopes. In referring to the opposite ends of the splint or scope, the xe2x80x9cproximal endxe2x80x9d refers to that part of the splint or scope which is closest to the control handle of the endoscope, and the xe2x80x9cdistal endxe2x80x9d refers to that part of the splint or scope farthest from the control handle.
In gastrointestinal endoscopy, especially colonoscopy, straightness of the endoscope is necessary or desirable for advancement of the endoscope. Colonoscopy is the most sensitive and specific means for examining the colon, particularly for the diagnosis of colon cancers and polyps. Because the cecum, the portion of the colon furthest from the anus, is a common location for cancer, it is important that the entire colon be completely examined. However, because the anatomy of the colon can extremely vary from person to person, the technique of total colonoscopy is technically demanding. During a colonoscopy, the scope is inserted in the anus, through the rectum, sigmoid colon, descending colon, transverse colon, ascending colon and then into the cecum. Advancing the scope, which is typically about 160 centimeters in length, can be difficult due to a loop in the sigmoid colon. Once the scope reaches the descending colon or transverse colon, this loop must be reduced by withdrawing the scope to a straightened position. Failure to straighten the loop in the sigmoid colon prior to continuing can cause enlargement of the loop and result in pain and damage, including adverse cardiac reactions such as hypotension and bradycardia. Once the loop is straightened, further advancement of the endoscope can usually be accomplished.
In not so uncommon circumstances, however, the sigmoid loop often has a tendency to reform upon readvancement of the endoscope. When this happens, a sigmoid splint, or overtube, can be useful in preventing reformation of the sigmoid loop and facilitate advancement of the scope to the cecum. As is well known, however, when the need for a sigmoid splint arises, the tip of the scope is usually already in the descending or transverse colon. At this point, the colonoscopist may opt to remove the scope entirely in order to load the endoscope inside the sigmoid splint, in an end-to-end fashion, onto the scope, and start the procedure over again. A more convenient way, however, is to be able to do so without having to remove the scope from the patient. This is typically done by using a splint with a longitudinal slot along the entire length of the splint. The splint is loaded onto the endoscope in a side-to-side fashion by opening the slot, such that the scope does not have to be removed from the patient. Once seated around the scope, the slot is closed. The slot will then need to be secured in the closed position. A fastening or locking mechanism is needed to keep it closed in a secure fashion.
3. Related Art
A splinting tube with a straight longitudinal slot, which enables side-to-side loading onto the scope, is available (Olympus America, Inc., Melville, N.Y.). Its slot is a simple straight opening along the length of the splint. Once loaded onto the colonscope, the slot is kept closed with one or more strips of adhesive tape. However, this fastening method is difficult because the adhesive tape, or part of it, may come off, especially when, as usual, there is lubricant on the splint and because even if it is securely taped, the tape fastens the slot only in two dimensions such that movement of the two edges against one another can still occur. Due to these limitations, the slotted splint described above is not widely utilized in endoscopic exams.
A different type of closure mechanism is described in U.S. Pat. No. 5,941,815 to Chang (the same inventor as of the present invention). In his patent, Chang describes a fastening mechanism using studs built onto one side of the slot, and receiving sockets on the other side of the slot. Closure of the slot is fastened by snapping these studs into the corresponding sockets. This fastening mechanism closes the slot in three dimensions. However, again, in the presence of lubricants, the fastened studs can still come off. Furthermore, the manufacturing process is very expensive. Another type of closure mechanism that has been disclosed is a zip-locking mechanism (i.e. similar to that used on plastic sandwich bags). However, the process of building a zip-locking mechanism into the wall of the splint is technically difficult, and the closure in the presence of lubricants still may not be very secure. If any bending of the splint occurs, and especially in the presence of lubricants, parts of the zip lock, along this approximately 40 cm length, can come apart.
What is needed is an improved securing mechanism for closing the longitudinal slot on splints used as an overtube for endoscopic procedures. Such an improved securing mechanism should provide a three-dimensional closure and alignment of the slot to securely fasten together and close the longitudinal slot. In addition, an improved securing mechanism should be unaffected by the presence of lubricants and bodily fluids. Ideally, such an improved securing mechanism should minimize the amount of labor and patient discomfort associated with utilizing a splint during an endoscopic procedure, such as a colonoscopy.
The locking mechanism for an endoscopic overtube of the present invention provides the benefits and solves the problems identified above. That is to say, the present invention discloses a highly secure fastening mechanism for splints having a longitudinal slot that provides three-dimiensional closure and alignment of the slot. The locking effect of the present invention is not affected by lubricants, which are almost always present in endoscopic procedures. To the best of the inventor""s knowledge, this endoscopic splinting device and this method of closure of its slot has never been described before. The locking mechanism of the present invention simplifies use of the splint during endoscopic procedures and reduces the labor required for those procedures and the likely discomfort of the patient.
In one embodiment of the present invention, the closure mechanism for a splint comprises an overtube made of a elongated Cylindrical or tubular member having two lumens placed in parallel relationship to one another. The larger lumen is sized and configured to receive the endoscope. The smaller locking lumen is used for the slot locking/fastening mechanism of the present invention. The slot is created by cutting one wall of the splint along its length. The cutting pattern involves one side of the locking lumen for a short distance, then crossing the locking lumen, then the other side of the locking lumen for a short distance, then crossing back to the first side again. This pattern is repeated many times along the entire length of the tubing. The end result is a longitudinal slot with a zig-zag, sine-wave, saw-toothed, or another interdigitating configuration. When the slot is closed, the locking lumen is aligned and continuous again. The cutting process can be performed with the die-cutting process. More than one smaller lumen may be utilized, with the extra lumen(s) being used for other purposes. The entire splint can also be made with the molding process. In use, after loading the scope into the splint through the open slot, the slot is closed and the locking lumen realigned. The closure is next locked into position with a string, wire or other elongated member by threading it through the locking lumen. After the string is pulled taut and anchored against the splint, a secure closure of the slot is accomplished.
Accordingly, the primary objective of the present invention is to provide a closure mechanism for an endoscopic overtube having the features generally described above and more specifically described below in the detailed description.
It is also an important objective of the present invention to provide a closure mechanism for an endoscopic overtube that securely closes the longitudinal slot on the overtube to facilitate use of the overtube in endoscopic procedures.
It is also an important objective of the present invention to provide a closure mechanism for an endoscopic overtube that comprises a slot having a plurality of interlocking components that join together to securely close the slot.
It is also an important objective of the present invention to provide a closure mechanism for an endoscopic overtube having a plurality of interlocking components that join together to securely close the slot and a separate locking lumen that interacts with the interlocking components to maintain the secure closure of the slot.
It is also an important objective of the present invention to provide a closure mechanism for an endoscopic overtube slot that utilizes a string, wire or other elongated member inside a separate lumen to facilitate the secure locking of the slot.
The above and other objectives of the present invention are explained in greater detail by reference to the attached figures and description of the preferred embodiment which follows. As set forth herein, the present invention resides in the novel features of form, construction, mode of operation and combination of parts presently described and understood by the claims.